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Morales-Roccuzzo D, Sabahi M, Obrzut M, Najera E, Monterroso-Cohen D, Bsat S, Adada B, Borghei-Razavi H. A primer to vascular anatomy of the brain: an overview on anterior compartment. Surg Radiol Anat 2024; 46:829-842. [PMID: 38630270 PMCID: PMC11161539 DOI: 10.1007/s00276-024-03359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/30/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE Knowledge of neurovascular anatomy is vital for neurosurgeons, neurologists, neuro-radiologists and anatomy students, amongst others, to fully comprehend the brain's anatomy with utmost depth. This paper aims to enhance the foundational knowledge of novice physicians in this area. METHOD A comprehensive literature review was carried out by searching the PubMed and Google Scholar databases using primary keywords related to brain vasculature, without date restrictions. The identified literature was meticulously examined and scrutinized. In the process of screening pertinent papers, further articles and book chapters were obtained through analysis and additional assessing of the reference lists. Additionally, four formalin-fixed, color latex-injected cadaveric specimens preserved in 70% ethanol solution were dissected under surgical microscope (Leica Microsystems Inc, 1700 Leider Ln, Buffalo Grove, IL 60089 USA). Using microneurosurgical as well as standard instruments, and a high-speed surgical drill (Stryker Instruments 1941 Stryker Way Portage, MI 49002 USA). Ulterior anatomical dissection was documented in microscopic images. RESULTS Encephalic circulation functions as a complex network of intertwined vessels. The Internal Carotid Arteries (ICAs) and the Vertebral Arteries (VAs), form the anterior and posterior arterial circulations, respectively. This work provides a detailed exploration of the neurovascular anatomy of the anterior circulation and its key structures, such as the Anterior Cerebral Artery (ACA) and the Middle Cerebral Artery (MCA). Embryology is also briefly covered, offering insights into the early development of the vascular structures of the central nervous system. Cerebral venous system was detailed, highlighting the major veins and tributaries involved in the drainage of blood from the intracranial compartment, with a focus on the role of the Internal Jugular Veins (IJVs) as the primary, although not exclusive, deoxygenated blood outflow pathway. CONCLUSION This work serves as initial guide, providing essential knowledge on neurovascular anatomy, hoping to reduce the initial impact when tackling the subject, albeit the intricate vasculature of the brain will necessitate further efforts to be conquered, that being crucial for neurosurgical and neurology related practice and clinical decision-making.
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Affiliation(s)
- Diego Morales-Roccuzzo
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Michal Obrzut
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Edinson Najera
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - David Monterroso-Cohen
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Shadi Bsat
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Prenc M, Žižek H, Radić P, Škoro M, Novak AM, Čulo B, Kalousek V. Step-by-step venous navigation in treatment of tentorial dural arteriovenous fistula supplied by artery of Bernasconi and Cassinari. Interv Neuroradiol 2024:15910199241258656. [PMID: 38819369 DOI: 10.1177/15910199241258656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
The artery of Bernasconi and Cassinari is a small infraclinoid branch of the internal carotid artery that originates from its cavernous segment and then runs along the tentorium. Because of its gracile appearance, it is often visible only when related to neoplasms and vascular lesions in the tentorial regions.1 Dural arteriovenous fistulas (dAVFs) are arteriovenous shunts contained within the dural leaflets, supplied largely by the regional meningeal arteries and classified based on the type of venous drainage. Tentorial dAVFs are mostly supplied by branches of the meningohypophyseal trunk, including the artery of Bernasconi and Cassinari.2 Unlike fistulas of other locations, tentorial fistulas are linked with a higher risk for venous hypertension and hemorrhage and thus demand immediate and appropriate treatment.3 Digital subtraction angiography is necessary to understand its arterial and venous components. Treatment aims to achieve complete embolization of the fistulous connection and venous portions by either a transarterial or transvenous approach, without causing serious changes in the flow dynamics.4, 5.
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Affiliation(s)
- Matea Prenc
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Helena Žižek
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Petra Radić
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Marija Škoro
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Ana-Marija Novak
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Branimir Čulo
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Vladimir Kalousek
- Department for Diagnostic and Interventional Radiology, University Hospital Centre Sisters of Charity, Zagreb, Croatia
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Kutia SA, Yarovaya OY, Kuznetsova EV, Obukhova DD, Kuznetsov VI. [Clinical anatomy of the Bernasconi-Cassinari artery]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:12-17. [PMID: 38512089 DOI: 10.17116/jnevro202412403212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The article provides a comprehensive overview of the Bernasconi-Cassinari's artery (marginal tentorial branch of internal carotid artery, r. marginalis tentorii a. carotis internae). It includes information on the history of its discovery, anatomical features, and topography. The interrelation between the anatomical features of this artery and the presence of neurological pathology in patients is discussed, along with neurosurgical treatment methodologies.
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Affiliation(s)
- S A Kutia
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - O Ya Yarovaya
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - E V Kuznetsova
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - D D Obukhova
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - V I Kuznetsov
- Vernadsky Crimean Federal University, Simferopol, Russia
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Arima H, Watanabe Y, Tanoue Y, Morisako H, Kawakami T, Ichinose T, Goto T. Angiographic Evaluation of the Feeding Artery in Skull Base Meningioma. J Clin Med 2023; 12:7717. [PMID: 38137785 PMCID: PMC10744082 DOI: 10.3390/jcm12247717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
To identify the characteristics of feeding arteries in skull base meningioma including location and prevalence, we evaluated the distributions and types of feeding arteries in skull base meningioma by cerebral angiography and assessed relationships to tumor attachment. We enrolled patients with skull base meningioma who underwent MRI and cerebral digital subtraction angiography (DSA), from September 2015 to October 2022. Subjects comprised 115 patients (32 males, 83 females; mean age, 52.7) with 117 meningiomas, showing tumor attachments around the "cavernous sinus to the upper part of the clivus" (Area 1), "lower part of the clivus to foramen magnum" (Area 2), and "tentorium around the petrous bone" (Area 3). Frequent arteries, such as the dorsal meningeal artery (DMA), the ascending pharyngeal artery (APA), the tentorial artery (TA), and the petrosal branch (PB) of the middle meningeal artery (MMA) were analyzed in terms of their associations with tumor attachment to Areas 1-3. Meningiomas with the DMA as a feeding artery correlated with tumor attachment to Area 1 (p < 0.001). Meningiomas with the APA correlated with tumor attachment to Area 2 (p < 0.001). Meningiomas with the TA correlated with tumor attachment to Area 3 (p < 0.001). The PB correlated with Area 3 (p < 0.05). Our study founded that visualization of these arteries correlated well with specific areas. These arteries were also the main feeders in each type of skull base meningioma.
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Affiliation(s)
- Hironori Arima
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Yusuke Watanabe
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Taichiro Kawakami
- Department of Neurosurgery, Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Tsutomu Ichinose
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University, Osaka 545-8585, Japan (H.M.); (T.G.)
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Dziedzic TA, Abhinav K, Fernandez-Miranda JC. Subtemporal Approach and Its Infratentorial Extension: Review and a Comparative Analysis of Different Techniques. J Neurol Surg B Skull Base 2022; 84:89-97. [PMID: 36743711 PMCID: PMC9897897 DOI: 10.1055/s-0041-1741566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Surgical resection of lesions occupying the incisural space is challenging. In a comparative fashion, we aimed to describe the anatomy and surgical approaches to the tentorial incisura and to the rostral brainstem via the intradural subtemporal approach and its infratentorial extensions. Methods Six fresh human head specimens (12 sides) were prepared for the microscopic dissection of the tentorial incisura using the intradural subtemporal approach and its infratentorial extensions. Endoscope was used to examine the anatomy of the region inadequately exposed with the microscope. Image-guided navigation was used to confirm bony structures visualized around the petrous apex. Results Standard subtemporal approach provides surgical access to the supratentorial brainstem above the pontomesencephalic sulcus and to the lateral surface of the cerebral peduncle. The linear or triangular tentorial divisions can provide access to the infratentorial space below the pontomesencephalic sulcus. The triangular tentorial flap in comparison with the linear incision obstructs the exposure of anterior incisural space and of the prepontine cistern. Visualization of the brainstem below the trigeminal nerve can be achieved by the anterior petrosectomy. Conclusion Infratentorial extension of the intradural subtemporal approach is technically demanding due to critical neurovascular structures and a relatively narrow corridor. In-depth anatomical knowledge is essential for the selection of the appropriate operative approach and safe surgical resections of lesions.
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Affiliation(s)
| | - Kumar Abhinav
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Center for Skull Base and Pituitary Neurosurgery, Southmead Hospital, Bristol, United Kingdom
| | - Juan C. Fernandez-Miranda
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States,Address for correspondence Juan C. Fernandez-Miranda, MD Department of Neurosurgery, Stanford University School of Medicine300 Pasteur Drive, Stanford, California, CA 94305-5327United States
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Quaranta L, De Simone R, Tavanti F, Biraschi F, Iani C. Focal status epilepticus in dural arteriovenous fistula detected after a two-step clinical course: a case report. Seizure 2021; 86:210-212. [PMID: 33558137 DOI: 10.1016/j.seizure.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Loreta Quaranta
- Emergency Department, Division of Neurology and Stroke Unit, Epilepsy Centre, S. Eugenio Hospital, Rome, Italy.
| | - Roberto De Simone
- Emergency Department, Division of Neurology and Stroke Unit, Epilepsy Centre, S. Eugenio Hospital, Rome, Italy
| | - Francesca Tavanti
- Department of Diagnostic Imaging and Interventional Radiology, S. Eugenio Hospital, Rome, Italy
| | | | - Cesare Iani
- Emergency Department, Division of Neurology and Stroke Unit, Epilepsy Centre, S. Eugenio Hospital, Rome, Italy
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Benner D, Hendricks BK, Benet A, Lawton MT. Eponyms in Vascular Neurosurgery: Comprehensive Review of 11 Arteries. World Neurosurg 2021; 151:249-257. [PMID: 33548525 DOI: 10.1016/j.wneu.2021.01.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/24/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anatomic knowledge and insight depend on the cumulative contributions of anatomists over time, and eponyms pay homage to some of these individuals. METHODS A PubMed literature review identified 11 eponymous arteries of the brain and spinal cord. RESULTS The 11 eponyms include the artery of Adamkiewicz, the artery of Bernasconi and Cassinari, the artery of Davidoff and Schechter, the recurrent artery of Heubner, McConnell's capsular arteries, the artery of Percheron, the artery of Salmon, the Vidian artery, the arteria termatica of Wilder, the circle of Willis, and the artery of Wollschlaeger and Wollschlaeger. CONCLUSIONS Eponyms remind us of an artery's importance and can improve our clinical acumen or technique. They have become an integral part of our day-to-day vocabulary, often without our historical knowledge of these anatomists. This report reviews these histories and the anatomy to deepen our appreciation of arterial eponyms in vascular neurosurgery.
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Affiliation(s)
- Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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A unique temporary collateral pathway between carotid-vertebrobasilar arteries in a carotid dissection patient. BMC Neurol 2020; 20:97. [PMID: 32183730 PMCID: PMC7076917 DOI: 10.1186/s12883-020-01651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background In adults, the anastomosis between carotid and vertebrobasilar arteries is usually the posterior communicating artery, sometimes the primitive trigeminal artery. In this case, the basilar artery fed the internal carotid artery through the pontine-to-tentorial artery anastomosis after severe stenosis from traumatic carotid dissection. Case presentation A 32-year-old female was diagnosed with ischemic stroke caused by traumatic carotid artery dissection. Aspirin (100 mg/day) and clopidogrel (75 mg/day) were prescribed. Digital subtraction angiography performed 6 days after stroke onset showed a dissection in the cervical segment of left internal carotid artery with severe local stenosis, and a collateral pathway from BA to the cavernous segment of internal carotid artery through the lateral pontine and tentorial artery. Without interventional therapy, clinical symptoms improved significantly within 10 days after onset. At 3-month follow-up, left common carotid artery angiography showed the stenosis had been significantly improved with a residual aneurysm. There was no collateral pathway between carotid-vertebrobasilar arteries, and a residual small artery originated from the posterior vertical segment of cavernous internal carotid artery. The small artery was clearly visualized by 3-dimensional rotational angiography and identified the tentorial artery. Conclusion To the author’s knowledge, this is the first report of a collateral pathway between carotid vertebrobasilar arteries through the pontine-to-tentorial artery anastomosis. Meanwhile, tentorial artery origination directly from the cavernous segment of internal carotid artery is rare and easily mistaken for persistent primitive trigeminal artery. 3-dimensional rotational angiography can provide sensitive and accurate diagnostic assessment of the small artery, and may be a useful tool for screening of abnormal small arteries.
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Tong D, Chen X, Lv X, Li K, Xu K, Yu J. Current status of endovascular treatment for dural arteriovenous fistulae in the tentorial middle region: a literature review. Acta Neurol Belg 2019; 119:5-14. [PMID: 30430430 DOI: 10.1007/s13760-018-1044-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
The tentorial middle region (TMR) includes the midline and paramedian tentorium. TMR dural arteriovenous fistulae (DAVFs) are complex. We performed a review of the literature on TMR DAVFs. TMR DAVFs are divided into the following four types: incisural DAVF, Galenic DAVF, straight sinus DAVF and torcular DAVF. TMR DAVFs often drain into pial veins; therefore, most TMR DAVFs are classified as Borden II-III and Cognard types IIb-IV, whose characteristics cause TMR DAVFs to be prone to hemorrhage. TMR DAVFs have a very disappointing natural progression, and treatment is necessary. TMR DAVFs have extensive arterial supply and complex venous drainages, making them difficult to treat. Currently, for TMR DAVF, endovascular treatment (EVT) has become a better option. In EVT, transarterial embolization is the first-line treatment. Many complications can occur when treating TMR DAVFs, but complete EVT can generally achieve good clinical outcomes. In this review, three educational cases with demonstrating figures are provided to elaborate TMR DAVFs.
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Affiliation(s)
- Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Litanglu 168#, Beijing, 102218, China
| | - Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
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Kutia SA, Kiselev VV, Pikaliuk VS, Moroz GA, Kriventsov MA. [Revisiting eponyms of arteries of the brain]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:45-48. [PMID: 28300803 DOI: 10.17116/jnevro201611612245-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes the eponymous terms in anatomical nomenclature of the cerebral arteries. There are historical references revealing the etymology of described eponyms, including information about the professional and personal life of doctors and scientists who had first discovered or described particular structure of the cerebral arterial network. Chronology of the discovery of the cerebral arterial circle is described in details. It is shown that some eponymous terms contain the names of several doctors who studied a particular medical issue simultaneously, which is a reflection of the stages of the medical science development and the evidence of the continuity of scientific knowledge.
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Affiliation(s)
- S A Kutia
- Vernadsky Crimean Federal University, Georgievsky Medical Academy, Simferopol, Russia
| | - V V Kiselev
- Vernadsky Crimean Federal University, Georgievsky Medical Academy, Simferopol, Russia
| | - V S Pikaliuk
- Vernadsky Crimean Federal University, Georgievsky Medical Academy, Simferopol, Russia
| | - G A Moroz
- Vernadsky Crimean Federal University, Georgievsky Medical Academy, Simferopol, Russia
| | - M A Kriventsov
- Vernadsky Crimean Federal University, Georgievsky Medical Academy, Simferopol, Russia
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Liu S, Lee DC, Tanoura T. Tentorial dural arteriovenous fistula of the medial tentorial artery. Radiol Case Rep 2016; 11:242-4. [PMID: 27594958 PMCID: PMC4996940 DOI: 10.1016/j.radcr.2016.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/22/2016] [Indexed: 11/26/2022] Open
Abstract
The medial tentorial artery arises from the meningohypophyseal trunk, a branch of the cavernous internal carotid artery, and it is poorly visualized on angiography in the absence of pathologically increased blood flow. We present the case of a 38-year-old man with intraventricular hemorrhage from a tentorial dural arteriovenous fistula (DAVF) singularly supplied by a robust medial tentorial artery. Tentorial DAVFs comprise a rare but high-risk subset of DAVFs. The diagnosis was suggested by computed tomography and magnetic resonance imaging findings and confirmed with digital subtraction angiography.
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Affiliation(s)
- Syrone Liu
- Department of Radiology, Harbor-UCLA Medical Center, 1000 W Carson St, Box 23, Torrance, CA 90509, USA
| | - Dane C Lee
- Department of Radiology, Harbor-UCLA Medical Center, 1000 W Carson St, Box 23, Torrance, CA 90509, USA
| | - Tad Tanoura
- Department of Radiology, Harbor-UCLA Medical Center, 1000 W Carson St, Box 23, Torrance, CA 90509, USA
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Intra-operative devascularization of petroclival meningiomas by ICG-VA-guided Bernasconi & Cassinari artery identification. Acta Neurochir (Wien) 2016; 158:427-8. [PMID: 26782829 DOI: 10.1007/s00701-016-2704-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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Byrne JV, Garcia M. Tentorial dural fistulas: endovascular management and description of the medial dural-tentorial branch of the superior cerebellar artery. AJNR Am J Neuroradiol 2013; 34:1798-804. [PMID: 23660293 DOI: 10.3174/ajnr.a3519] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE TDAVFs are uncommon causes of spontaneous intracranial hemorrhage. A retrospective review of their management was performed after repeatedly observing a previously under-recognized medial dural-tentorial branch of the SCA. MATERIALS AND METHODS Thirteen patients were diagnosed with TDAVFs by CT/MR imaging and DSA during a 5.8-year period. Seven patients presented after intracranial hemorrhage. Twelve patients were treated endovascularly, and one, surgically. RESULTS Eleven TDAVFs were located in the midline (7 at the falx cerebelli and 4 at the torcular), and 2 were petrotentorial. All torcular TDAVFs were associated with sinus thrombosis and showed bidirectional drainage relative to the tentorium. No sinus thrombosis was seen in the falx cerebelli subtype, which drained infratentorially only, except in 1 patient who had had unrelated surgery previously. Venous drainage was directly to cortical veins except for 1 petrotentorial and 2 torcular TDAVFs. A branch of the SCA, the medial dural-tentorial artery, was observed in 5 midline TDAVFs. Its anatomy was defined with selective angiography. Endovascular therapy resulted in a cure in 5 and subtotal occlusion in 6, and staged treatment is ongoing in 1 patient. One patient was cured after surgery. CONCLUSIONS TDAVFs frequently cause intracranial hemorrhage and therefore warrant treatment. Endovascular therapy proved effective in this series, and arteriography was essential for understanding the various fistula subtypes and for treatment planning. We emphasize the importance of recognizing the medial dural-tentorial artery of the SCA with its characteristic course along the tentorium on angiography. This artery should be included in future anatomic descriptions of the cranial blood supply.
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Affiliation(s)
- J V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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